What is the final stage of dying
The five stages of death
Phase 1: Hope for error
The psychiatrist Elisabeth Kübler-Ross calls the first phase "not wanting to believe" (English "denial"): At this stage, the person affected learns of his fatal illness and does not want to acknowledge it. He believes in a mix-up, in the lack of competence of his doctors and seeks other doctors in the hope of clearing up this mistake.
Often those affected do not change anything in their life at first, but continue to live as before. The palliative medicine specialist Professor Christoph Student advises dying attendants in this phase to accept this behavior: "Sometimes we would like to shake the sick in this phase, wake them up: 'See how things are really going with you. Don't waste time with unnecessary more Investigations. Finally start treatment. ' But that's our point of view. It may be right for us. But that doesn't count now. " Another question is asked: to stick to it, not to leave the sick alone and to (actively) listen.
Phase 2: Asking why
The second phase is that of "anger": The dying person has accepted his diagnosis, but reacts negatively to his environment, possibly insulting healthy people because he is driven by the question: Why does it hit me of all people?
In this phase, the dying person finds a valve to let off steam, explains Christoph Student: "As long as we can see the connection between the illness and the angry reaction, it may all be tolerable.
It becomes more difficult when the sick person is simply nagging, when we cannot please her or him in any way, when the sick keep us on our toes by constantly ringing the bell, when many subliminal little pinpricks make us white-hot. "
His advice to those helping: protect yourself, but don't turn away from the sick. It makes more sense to stay close to the person affected and to take his or her justified complaints seriously, but still to separate oneself emotionally so that the helpers can endure the dying person's reactions.
Phase 3: Desire for postponement
In the third, usually rather short phase of "bargaining", the patient tries to get reprieve. He negotiates with doctors, confidants and God about what he would do if he were allowed this time - wishes such as witnessing family events such as births or weddings are often the focus.
The dying person is cooperative and takes part in many therapies. Palliative medicine specialist Christoph Student advises those helping to avoid evaluations. To some extent, support is good in this regard: "Allowing hope - but without fueling hopes that we consider unrealistic."
Phase 4: mourning missed opportunities
The fourth phase of death is that of "depression": The terminally ill falls into a depressive mood, mourning possibly lost opportunities in life. But the grief for his life, which he will lose, is also present in this phase. It is often precisely at this point that the dying take care of things that they still want to take care of themselves, such as their wills.
According to Kübler-Ross, this phase of death is also characterized by the fact that the patient does not want to allow any new therapies, although relatives and doctors may still see an opportunity in this. During this time, sick people often have a great need to communicate. Student explains another aspect of this stage: "They want to express their grief, they want us to hear their complaints. It is good for them if we listen to them intensely."
When the sick person has formulated part of his burden, he may have gotten rid of that part of the burden and is relieved. "When we try to console him, we shut his mouth, so to speak," said Student. Some seriously ill people are relieved in this phase when the carers support them with the important question of how their family's life can go on without them.
Phase 5: Decoupling from the environment
The fifth and last phase of death according to Kübler-Ross does not reach all dying people: "Acceptance". Many dying people have now fully accepted their fate. They slowly disconnect from their environment, often no longer have a great desire to receive visitors, and longer conversations are no longer desirable.
The palliative medicine specialist Christoph Student states: "As helpers, we are only required as silent participants who can perceive without fear that silence is now the most sensible form of communication."
Dying attendants should now pay special attention to the relatives by making it clear to them that the withdrawal of the loved one has nothing to do with rejection, but that he only wishes to be allowed to die.
"It doesn't matter now that the relatives let go of the dying person, let them go. That is usually too much to ask and is unnecessarily overwhelming." But maybe the relatives will be able to give something like a permit that the terminally ill person can go now, said student.
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